Perubahan Perilaku pada Remaja Penderita Migren Setelah Mendapat Terapi Profilaksis Amitriptilin

Abstract

Background. Migraine is a frequent phenomenon and several studies describe the personality characteristics and behaviors associated with incident migraine. Objective. To investigate whether therapy prophylaxis with amitriptyline has an effect on behavior of children with migraine. Methode. We conducted a single-blind randomized placebo-controlled clinical trial study in Medan, province of Sumatera Utara from July 2009 until December 2009. Participants eligible for migraine according to International Headache Society criteria were included in the study. They were divided into two groups, each group was given 10 mg per day of amitriptyline or placebo for 12 weeks. Headache frequency was measured in headache days per month. Duration was measured in hours and functional disability was measured by Pediatric Migraine Disability Assessment Scale (PedMIDAS). The behavior were evaluated with Child Behavior Check List (CBCL) before and 6 months after intervention. Results. After 6 months, A total of 98 patients, ranging in age from 12 – 19 years (mean age 15.0 years) were enrolled to the study. There was no significant difference on score between amitriptyline and placebo group after intervention. There was statistically significant decreased on internalizing, withdrawn and somatic complaint score of treatment group with amitriptyline after intervention (p<0,05) and there was no significant decreased in the placebo group. Conclusion. There was significant decreased on internalizing, withdrawn and somatic complaint of CBCL scores in children who was on the treatment group with amitriptyline.

Latar belakang. Migren merupakan fenomena yang sering dialami dan beberapa penelitian mendeskripsikan adanya karakteristik kepribadian dan tingkah laku yang berkaitan dengan kejadian migren. Tujuan. Untuk mengetahui perubahan perilaku pada remaja penderita migren setelah mendapat terapi propilaksis amitriptilin. Metode. Uji klinis acak tersamar tunggal dilaksanakan di Medan provinsi Sumatera Utara pada bulan Juli 2009 - Desember 2009. Migren ditentukan berdasarkan anamnesis, pemeriksaaan neurologi yang mendasarinya dan pemeriksaan frekuensi, durasi serta severity migren berdasarkan Pediatric Migraine Disability Assessment Scale (PedMIDAS).kemudian secara acak dibagi atas kelompok intervensi yang mendapat terapi amitriptilin 10 mg/hari dan kelompok plasebo. Terapi diberikan selama 3 bulan. Orang tua diminta untuk mengisi kuesioner Child Behavior Check List (CBCL) sebelum dan 6 bulan setelah intervensi. Hasil. Setelah 6 bulan, 98 anak mengikuti penelitian sampai akhir dengan umur 12-19 tahun (rata-rata 15,0 tahun). Tampak perbedaan yang bermakna pada skor T internalisasi antara kelompok amitriptilin dan plasebo (p=0.016). Perbedaan bermakna juga pada withdrawn dan somatic complaint antara kedua kelompok (p=0.015 dan p=0.001). Tidak dijumpai perbedaan proporsi anak dengan skor T > 60 setelah intervensi antara kedua kelompok. Dijumpai penurunan skor T internalisasi, skor T total, withdrawn dan somatic complaint yang bermakna secara statistik pada kelompok amitriptilin setelah intervensi (p<0,05) dibandingkan sebelum intervensi dan tidak dijumpai perubahan bermakna pada kelompok plasebo. Kesimpulan. Pada kelompok amitriptilin didapati penurunan skor T CBCL yang bermakna setelah intervensi dibandingkan sebelumnya dalam masalah internalisasi, withdrawn dan somatic complaint.